Bunion (hallux valgus, hallux)
Hallux valgus, commonly called hallux, is a deformation of the foot primarily characterized by lateral deviation of the big toe. This affliction affects women in a much greater extent, and all the same this is a much more complex pathology involving not only the big toe, but also the forefoot.
FACTORS GENERATING HALLUX
Hallux is the result of among all:
- wearing too tight shoes
- high heels or narrow shoe noses
Unfortunately, few people are aware that an improperly constructed heel causes the overload of the forefoot, resulting in an incorrect position of the fingers.
It has been found that wearing this type of footwear strongly intensifies pain, but is not its direct cause.
A significant role is played by the predisposition of the foot construction, as well as genetic predisposition. Along with hallux valgus, varus of the first metatarsal bone occurs, causing expansion of the transverse dimension of the foot.
These changes are accompanied by:
- local inflammation in the area of the head and the first metatarsal
- the occurrence of a painful tumor, called a bunion
- limiting the mobility of the metatarsal-phalangeal great toe, which, together with the progression of the disease can lead to joint subluxation.
In the advanced form of the discussed pathology, pain not only within the big toe, but on almost the entire area of the foot may occur.
In addition, there are deformities of fingers II-V, characterized by hyperextension in the metatarsal-phalangeal joints as well as flexion contracture in the interphalangeal joints. These are so-called hammer toes. These distortions lead to the development of degenerative changes, and at times it happens that the big toe crosses finger II or rotates around itself. These symptoms cause difficulties in adjusting and wearing footwear and greatly hinder movement.
Due to deformations of the big toe, the biomechanics of the foot change, and subsequently the following changes:
- body weight is not evenly distributed, the toe is no longer a good point of support for the foot
- the durability of supporting structures and muscles stabilizing the foot deteriorates
- muscles are weakened, and in some cases, there is even inflammation of the articular capsule.
THE MOST COMMON CAUSESOF DEORMTION (HALLUX)
- This distortion is much more common in women than men, especially after the age of 45, however currently more frequently this disease is observed in young women, already around 20 years of age. This is mainly cause due to walking in shoes that have too narrow tips, often in high heels, because the use of this type of footwear causes excessive lateral pressure on the toe resulting in hallux valgus.
- The reason may also be the co-existence of:
- longitudinal flatfoot
- contracture of the Achilles tendon and the gastrocnemius muscle
- generalized laxity
- rheumatoid arthritis
- past injuries
- Excessive load on the lower limbs as a result of excessive weight or spending too much time in a standing position, e.g. at work, is another reason of hallux.
Apart from the mentioned acquired causes of hallux valgus, this condition may occur through inheritance (especially in the female line). Hallux valgus occurs mostly in women, because their feet are characterized by much weaker ligament-capsular construction than the feet of men. Therefore, these changes usually (approximately in 80% of cases) are present on both sides, though not necessarily at the same time and prove varying degrees of severity.
Fig. 1 Hallux valgus (hallux, bunions)
HALLUX VALGUS DIAGNOSIS
Hallux valgus diagnosis is based on visible changes and symptoms reported by the patient. In the case of substantial pain persisting, inter alia hypertrophy of the distal base of the metatarsal-phalangeal toe, surgery is advisable. Then, in order to qualify for surgical treatment, a foot X-ray in a standing position is performed (due to the load).
In case of a less severe stage of pathology, conservative treatment may be used involving the wear of special orthopedic inserts bending the toe outwards. Usually, a silicone insert is placed between the finger and the second finger.